Tylor Pravongviengkham, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT-002670 Issued in AZ

Practice address

4915 E Baseline Rd Ste 115
Gilbert, AZ 85234-2966

Phone

(480) 279-4400

NPI assigned

Jan 10, 2022

Last updated

Feb 27, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pennsylvania College of Optometry, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Richard E Wood OD and Associates LLCGroup PAC ID 9234139320, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Richard E Wood OD and Associates LLC

  dba Fauquier Eye Care

  • Optometrist
  • Warrenton, VA
  • NPI 1013940824

  AZ

  Medicare reassignment Care Compare group NPD
• Gilbert Family Eyecare

  • Optometrist
  • Gilbert, AZ
  • NPI 1922289313
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1235880493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD STE 115",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-279-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4915 E BASELINE RD STE 115",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342966",
            "telephone_number": "480-279-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRAVONGVIENGKHAM",
        "first_name": "TYLOR",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-10",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandria Powers
• Lauren Michelle Powers, MS, LAT, ATC, CSCS
• Jamie Joseph Pozniak, PA-C
• Practical Life Counseling, PLLC
• Kenia Prado Merino
• Rachel E. Prazer, CRNA
• PRD Partners PLLC (Power Ranch Dental)
• Jessica Prebish, D.P.M
• Rebekah Grace Precht
• Precision Behavioral Consulting LLC

• Optometrist in Gilbert, AZ
• Providers in Gilbert, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.